Friday, October 24, 2008

First race was a 30 lap Scratch race. Went out on a 51x15 (about 88"). Pace was not quite as bad as last week (A's had their own race tonight) but still found I was struggling to keep up. Gear too low and race to short...

Next was an Elimination, again, too small gear and was an early volunteer at the back when I couldn't find a hole...

Final was a 4x10 Points race. Moved up to 51x14 (about 93"). Felt much more comfortable. Took 2nd in the first sprint. And did a good effort at the end... but unfortunately I didn't realize a small group had got off the front at the second last sprint... So I was sprinting for 5th... :-) But the bigger gear definitely felt more comfortable.

Friday, October 17, 2008

First was an Elimination, I got stuck at the back and didn't feel like fighting for a hole and took an early trip to the infield...

Next was a 4x10 Points race... fast.. I sat at the back and let the young guys duke it out for the

first 30 laps, at one point about 10 laps average speed about 49km/h, then moved towards the front for the final 10 laps, average speed about 48km/h, then final sprint up to 58km/h for the finish. I think I was lapped several times by Kirk Obee and a couple of other A's and I was in the main field. The last 10 laps was fun. The main field had thinned out so there was room to move around and do something.

Last was a 25 lap Point-a-lap. Started out with a couple of warm up laps at > 50km/h... Then slowed down to a more sedate 46km/h for a few laps, then back up again... Did I mention that Kirk Obee (and one or two other A's) passed me in lap 4... my average speed until then was 48km/h. From that point it was more or less impossible to tell who or what or where the actual front of the field was... I just kept sucking it up and trying to find someone to work with to try and bridge back to what appeared to be the main field... well at least it was the next biggest group on the track.. About 6-7 laps average speed 49km/h. At that point I (me!!) started to see some lapped riders but with only a few laps to go with Kirk Obee passing by for about the 4th time I found a wheel and rode home on Anthony Kings wheel for the last two laps.

Tuesday, October 14, 2008

Did Westwood and Johnson Road... both close to home. Which was important as it was cool (10C) and getting dark as I finished... So I could head straight home.

I wasn't pushing especially hard, (280-300 watts) and had the big 12-27 cassette on... but these two 16-18 minutes climbs felt very easy at this rate. And while not my best times, certainly not that bad either. My best ever time for Johnson is just under 17 minutes. I was about 19 and change tonight... The former (this spring) was fall over at the top hard... Tonight I was barely breathing hard at the top...

An interesting effect of the large amount of recent track work and climbing cassette... I had the impression that my legs where doing really big (and easy) circles.. (the road bike has 172.5mm cranks, the track bike is 170mm.) A bit strange how muscle memory can "feel" the difference..

Monday, October 13, 2008

My shoulder continues to feel great... There are still a few spots at the outside range of movement where I can still feel twinges.. But I suspect that may be due to lack of strength. It is certainly much easier to do most of the physio shoulder exercises now. Including actually being able to do some that I simply couldn't before

So the question now, is this a temporary relief, or can I hope for long term benefits.

From the reading below, it appears that the role of the cortisone is NOT for pain relief directly, but is for it's anti-inflamatory effects. The cortisone plus the dilation and rupturing of the capsule is to get the inflammation of that area to be reduced. Frozen shoulder can be thought of as a type of positive feedback loop, the more inflamed the area gets, the worse it gets and the more inflamed it gets... etc. This procedure hopes to break the feedback loop.

The studies seem to show that there is lasting effect as compared to other treatments and placebo, with few people requiring a second treatment and very very few people needing more than two treatments.

As a clinical entity, frozen shoulder (adhesive capsulitis) is relatively easy to diagnose, although treatment of this condition can be frustrating. But subtle forms of capsular restriction can either mimic or enhance other causes of shoulder pain, such as a subacromial impingement. If a patient with shoulder pain presents with nocturnal pain (in the absence of a rotator cuff tear), and their range of motion is subtly restricted in end abduction, internal rotation and horizontal flexion, and their anterior-posterior glide is diminished, then a component of capsular restriction should be considered. In cases of subacromial impingement in which this capsular restriction is present, it is very difficult to treat the impingement successfully without dealing with the capsular restriction.

Capsular restriction does not usually respond favourably to manual therapy.Often attempts to mobilise the shoulder result in a flare-up of the patient’s pain. One efficient way to treat these patients is with a hydrodilatation procedure. This is performed by a radiologist under X-ray control. A needle is inserted into the offending glenohumeral joint, and a mixture of corticosteroid, local anaesthetic and saline is injected. A large volume is required, and in ideal circumstances capsular rupture is achieved. When this happens, the communication between the shoulder joint and the subscapularis bursa is seen to open up. If this treatment is successful, it is very rewarding and satisfying for practitioner and patient alike. It also allows for expedient rehabilitation of the coexisting condition.

The above matches my current experience. Very little progress with exercises and other physiotherapies. Just changing areas where the pain was. But (almost) immediate relief after treatment, and with subsequent ability to do a much wider range of exercises... My Simple Shoulder Test (see below) score went from about 8-9 out of 12 to about 2-3.

Note 1 - Frozen Shoulder is same as Adhesive Capsulitis

Note 2 - Hyrdodialation, or Distension Arthography is a technique using cortisone and saline solution to treat a Frozen shoulder.

Friday, October 10, 2008

Tonight we had A and B groups combined again for a total of 20 riders (7 A, 13 B).

So very fast paced...

The first race was an Elimination to 10 lap scratch (20 down to 10 riders.) I didn't manage to get a good position at the front and had to duke it out at the back... Which I'm really not good at... Sprinting every 35 seconds or therabouts... Just not something I'm good at. I did managed to get towards the front once, but the pace was a hectic 47km/h and I just couldn't find a hole to drop into. And at that speed I couldn't sit up on the Blue line for long. So ended up at the back again.. I think I was 5th or 6th rider eliminated. Dave Kosic had a very good race, managing to get a good position during the elimination and staying in for the entire race.

The second race was a 40 Lap Scratch. Again pace was high, over 45km/h. I was staying at the back to keep out of trouble, and unfortunately about lap 25 my group got gapped by the lead group. I tried to jump and bridge but didn't quite make it.. Ended up about 40m back and pushing wind at 45km/h. Managed to do that for about 8 laps... By that time most of the gapped riders had been pulled, and as the lead group got close to me I was pulled so that they could do their last 4 lap sprint without having to go over any slower riders.

The final race race was a 6x10 Points race. Again I was comfortably hanging out at the back... The first 10 laps was very slow, about 39km/h.. but then picked up to 47-48km/h. My end group again got gapped, but this time I was able to jump and bridge up to the lead group. And then hang on while my heart rate got back down... Smaller (but much faster) group. Managed to get a good position and try for the 4th sprint (thanks to Mike Rothengaler, I think he let me have it), got 4th. Then 5th or 6th on the 5th sprint. And managed to stay with the group for the final sprint ..

Overall my best "performance" of the night, wattage wise (not tactically) was the first bridging attempt. Did 5 minutes with average speed of 48.2km/h, peak speed of 59km/h. Pavg 270 watts with peak watts at 662. Good numbers for me.

Playing the "old guy" card here... I'll note that 3 of the A riders are U19 stars, with a total age of 53.. so I beat them by one at 54 :-)

In China they make you pay for the bullet.... in BC if you need a Cortisone injection you have to buy the Cortinsone yourself :-)

After the MRI (the radiologist suggested an impingement and possibly a laberal tear) my GP got me referred to a an ortho-surg via the cast clinic at the local hospital (it is reasonably easy to get in appointments for these, but you get about 2-3 minutes of his time typically.)

He looked at the MRI, said it was inconclusive at best... that he didn't do "elective shoulder surgery" and said he would refer me to another ortho-surg who specializes in shoulders. That took almost a month... (the GP said it could have taken HIM almost a year to get me in to this guy..)

That new ortho-surg's (who is highly recommended by my wife the physio and her physio friends and my GP) first diagnosis was a possible frozen shoulder. (I think this link is good overview.) His first suggestion was that we try a cortisone injection.

I had that done yesterday. A fairly complicated procedure done by a radiologist. They light freeze the skin over the shoulder (lydicaine I think she said). Then using the X-ray machine they place a needle into the general area of the joint capsule. Next they inject a dye that allows them to see the capsule better and replace the needle to get it into the capsule.

Next they shoot in saline solution to distend the joint. Then the cortisone. Two vials of 40mg. Along with a bunch of saline solution. The instructions from the ortho-surg where to "rupture" the capsule. Presumbaly so that the cortisone would get into a wider area. The effect felt much like a small balloon in there.. unconfortable but not painful (like eating too much turkey dinner at Thanksgiving.)

All in all, took longer than I thought it would, about 30-35 minutes. And not was painful or traumatic as you might think. Fun if you like watching the TV monitor of the X-ray to see what is happening. Kind of like an episode of House (but without blood squirting all over the place, although at one point there was a nice spray of saline..)

The effect overall seems fairly effective 24 hours in. The shoulder is still very weak in the areas where the impingement was. But certainly at this point a lot less pain. Only time will tell if this is just a temporary or permanent change.

The plan is to continue the shoulder and physio exercises. Which with less pain may get me into better condition. Which may keep the situation under control. They will repeat once if the situation warrants.

Longer term if a second injection doesn't do the trick either then he (ortho-surg) will look at surgery. The problem being his waiting list is about two years... But at least at this point I'm (hopefully) on the list.

Anyway I'm back to the orth-surg in January time frame. Which gives me three months to see what this does for us.

The good news all along is that for the most part this has not impacted training. I only have problems on the bike if I go out for longer than 3-4 hours.

What has been a problem is sleeping. The shoulder pain tends to be noticable and recurrent mostly at night (when in-active). And typically will wake me up in the middle of the night. So I end up taking ibuprofen about 2-3 nights a week to get back to sleep.

[Soapbox mode on]

I still have no explanation from anyone why you have to buy and bring your own Cortisone. Not particularily expensive at $26Cdn... Given what the procedure cost overall (a half hour plus of X-Ray room in Vancouvers 2nd or 3rd largest hospital, radioligist and assistant, x-ray dye, saline, disposable needles and syringes etc) I can't believe that $26 (or probably half that if the hospital was paying for it wholesale) would be more than a few percent of the total. Go figure.

Saturday, October 4, 2008

Last night was the season BVC Friday night racing opener, short and fast...

There where 12 B racers and only 3 A's, so they joined us...

Started out with a 4 lap heats. Three sets of five, no neutral lap, first across the line in 4 laps wins... I was pretty sure I wasn't going to be in the top three at the end... and ended up at the end of the bunch in the first lap.. with everyone going high up to the blue line... So jumped down and sprinted out for two laps.. About 30 seconds peak speed of 54.2 km/h. Peak watts about 816, Pavg 547... Then pulled up and let the field take the last two laps... Bruce Denis (A rider) took first I think...

I was on 51x14 for the above. Which I have been finding quite comfortable for training on. But I found I was still "spinning out" up around 54/55 km/h. So I switched up to 52x14 for the rest of the evening.

Next was a 30 lap scratch race. The three A riders kept the pace up nicely.. We did the first 25 or so laps at an average speed of 45 km/h (peak 56!)... I just stayed at the back and out of trouble. With about 5 to go I started moving up the field and managed to get into a nice position for the last lap and a half. Unfortunately I just didn't have the leg speed/power to crack it up past 57 km/h. The front of the field moved away to the finish with about another two or three going over me, at about 60 km/h (John Perkins said he finished at 62, Bruce Denis 61.)

The last race was an Elimination. My only strategy in these is to get to the front or I'm toast... And with the 3 A riders controlling the front I just couldn't get up there.. They actually where not going that fast, but they kept control of the pace and made it difficult to get up there. So after about 3-4 eliminations I had no place to go and was out.

The slightly higher gearing was comfortable at these speeds. But I'll need to work on either leg speed or power so I can work a final sprint up to 60km/h...

I finished the night with a half hour of points race drill (8 laps slow, 2 laps sprint, 4 times) and then a cool down.

Today my legs feel very tired... full of lactic acid.. While the TSS points for last night was low.. only 72, there was a lot of intensity.

As you can see in the power distribution chart, a significant amount of time spent in anaerobic capacity...

Friday, October 3, 2008

Trolling tonight and found this paper on keeping fit as you age... called Beat the Clock.

With the right training, most people can be as fit in their 50s as they were in their 20s. Rick Lovett puts his 48-year-old body through its paces.Rick Lovett is a writer and runner based in Portland, Oregon, USA

Mainly with a runners perspective, but I think the overall conclusions and suggestions are germane to cyclists as well.